Additional mental health problems are substantially increased amongst people with neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and global intellectual disability (ID). Children and adolescents with neurodevelopmental disorders are three to six times more likely than their peers to have other mental disorders such as anxiety, depression and antisocial behaviour. Furthermore, these additional disorders are less likely to be recognized, diagnosed and treated.
The work of this group aims to understand the causes, evaluate treatments and improve the recognition of mental disorders in this group of children.
Co-occurring psychiatric disorders in children with Autism Spectrum Disorder/ADH.
Watch Professor Emily Simonoff, Professor of Child and Adolescent Psychiatry and Head of the Department for Child and Adolescent Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience lecture at Cereba's Annual Conference.
People
Professor of Child and Adolescent Psychiatry
Projects
IAMHealth - Funded by NIHR
The IAMHealth study is a programme grant funded by the National Institute of Health Research (NIHR), entitled ‘Improving outcomes for people with autism spectrum disorders by reducing mental health problems’. The programme started in May 2014 and will run for five years. The principal investigator on this project is Professor Emily Simonoff. The grant co-applicants are Professors Tony Charman, Declan Murphy, Stephen Scott, Gillian Baird, Bryony Beresford, Martin Knapp, Andrew Pickles, Dr Paramala Santosh, Dr Vicky Slonims and Ms Carol Povey. The research administrator is Monika Kovacs. This programme focuses on decreasing mental health problems as a strategy for improving outcomes for people with ASD and their families. These outcomes include improved mental health, quality of life and community participation for people with ASD; reduced family stress; and decreased economic costs by ultimately lowering the need for high-cost (often residential) care and integration into the community. We aim to improve identification of mental health problems by developing a tool for clinical use, which can also be used to monitor treatment response. We are undertaking qualitative work with parents, young people and adults with ASD to better understand which problems are most impairing, how families interpret maladaptive behaviours and their experiences of help-seeking. We are studying the early childhood risk/protective factors that differentiate the 20% of young people with ASD who develop SMB in adolescence, so that resources can be better focused to those at highest risk. Finally, we will develop and pilot an early intervention for parents aimed at reducing the risk behaviours, increasing parental understanding of mental health and ASD, and promoting resilience as a strategy to prevent the development of the most severe maladaptive behaviour. This programme involves a partnership with people with ASD, their families and the National Autistic Society (NAS). Dissemination of our findings will be led by the NAS.
SNAP (Special Needs in Autism)
SNAP (Special Needs in Autism) - Why do People with Autism Spectrum Disorders Fare so Differently in Adult Life? There is widespread concern about the adult development and outcomes for people with ASD. We are studying the Special Needs and Autism Project (SNAP) cohort, a well-characterized, longitudinal and population-representative sample of young adults with ASD to answer the following questions: (1) What is the range of outcomes for young adults? (2) What are the factors, especially from childhood and adolescence, that predict good vs. poor outcome? (3) What are the drivers of the high economic costs of ASD in adulthood, and how far can they be predicted from childhood? and (4) Can we reliably use cognitive markers for associated psychiatric problems that may help in earlier diagnosis and treatment of these additional problems? Our ultimate aim is to find novel ways to improve outcome by treating additional impairing problems. SNAP was identified from the general population, rather than from clinics, and represents the entire spectrum with respect to autism severity, IQ and family characteristics. Therefore findings from this study should represent all young adults with ASD, not just those accessing services. The cohort was previously assessed at 11/12 and 15/16 years. We are now re-assessing them at age 22/23 years because this is at the end of educational provision and a crucial time to enter employment and develop increasing independence. Findings from the SNAP cohort have been influential in the field of autism internationally, including in the estimation of prevalence, the importance of co-occurring psychiatric problems, and the nature of the cognitive phenotype. To date, there are over 30 peer-reviewed publications from SNAP published/in press/in submission. Lead Investigators: Professor Emily Simonoff, Professor Tony Charman Research Team: Jackie Briskman, Dr Rachel Kent
Validation of cognitive and physiological biomarkers of childhood anxiety in children with autism spectrum disorders
This research studies the cognitive, physiological and neuroendocrine correlates of anxiety in adolescents with autism, compared to healthy controls. Anxiety disorders are difficult to recognize in people with autism because of their communication problems. The aim of this research is to determine whether reported anxiety symptoms in young people with autism show similar cognitive and biological correlates as reported in typically developing children. It is partly funded by South London and Maudsley Charitable Foundation.
Correlates and consequences of specific language impairment: development during the first 3 years of schooling
This study determines the prevalence of specific speech and language impairments in children during their first year at school and identifies the associated neurodevelopmental and mental health problems that co-occur and develop over the early years of schooling. The study will provide a better understanding of the relation between specific impairments associated with speech and language disorders and their links to neurodevelopmental disorders. PI: Prof Courtenay Norbury, Royal Holloway It is funded by Welcome Trust.
Completed Projects
Evaluation of Diagnostic Techniques, and Cognitive and Physiological Correlates, of Anxiety in Young People with Autism Spectrum Disorders
One in ten young people under the age of 16 in the UK is thought to suffer from some form of anxiety. In children and young people with ASD, findings from epidemiological research (Simonoff et al., 2008) suggest that as many as 40% have an anxiety disorder. However, recognition and diagnosis is difficult because children with ASD may not be able to describe their feelings and emotions clearly and because anxiety symptoms can be superficially similar to core symptoms of ASD, for example social lack of interest (ASD) versus social avoidance (anxiety).
We undertook a study to examine the cognitive and biological basis of anxiety symptoms in ASD. We compared boys aged 10-16 years with ASD, either with or without an anxiety disorder, to typically developing (TD) boys on a range of cognitive and biological parameters, including during a psychosocial stress test.
This study ran between 2009-2013 and was funded by the NIHR Biomedical Research Centre for Mental Health, as one of three BRC-funded research themes within the Department of Child and Adolescent Psychiatry.
Genetic Architecture of Disruptive Disorders
Behaviour genetic studies of antisocial and aggressive behaviours have suggested that heritability for an underlying trait, as measured by both parent and child reports, may be much higher than those of individual reports. Parent and child reports contribute uniquely as each reflects different aspects of antisocial behaviour. There is some evidence that aggressive behaviour may be more highly genetically loaded than some other areas of antisocial behaviour.
Our research agrees with other studies in finding a strong genetic component to hyperactivity (attention deficit hyperactivity disorder) symptoms. It further highlights the need for considering ratings from teachers as well as parents, in taking account of behaviour that is developmentally appropriate
Aetiological Risk Factors for Moderate Learning Disabilities
Our general population study of over 2500 adolescents attending both mainstream and special schools revealed that definite medical disorders likely to account for moderate learning disability (IQ < 70) were present in just under 9% of the population. Psychiatric symptoms were increased in those with MLD, with ADHD symptoms increased 5.5-fold and emotional symptoms increased 5.8-fold. Most children (? 80%) with moderate learning disabilities were attending mainstream school.
People
Professor of Child and Adolescent Psychiatry
Projects
IAMHealth - Funded by NIHR
The IAMHealth study is a programme grant funded by the National Institute of Health Research (NIHR), entitled ‘Improving outcomes for people with autism spectrum disorders by reducing mental health problems’. The programme started in May 2014 and will run for five years. The principal investigator on this project is Professor Emily Simonoff. The grant co-applicants are Professors Tony Charman, Declan Murphy, Stephen Scott, Gillian Baird, Bryony Beresford, Martin Knapp, Andrew Pickles, Dr Paramala Santosh, Dr Vicky Slonims and Ms Carol Povey. The research administrator is Monika Kovacs. This programme focuses on decreasing mental health problems as a strategy for improving outcomes for people with ASD and their families. These outcomes include improved mental health, quality of life and community participation for people with ASD; reduced family stress; and decreased economic costs by ultimately lowering the need for high-cost (often residential) care and integration into the community. We aim to improve identification of mental health problems by developing a tool for clinical use, which can also be used to monitor treatment response. We are undertaking qualitative work with parents, young people and adults with ASD to better understand which problems are most impairing, how families interpret maladaptive behaviours and their experiences of help-seeking. We are studying the early childhood risk/protective factors that differentiate the 20% of young people with ASD who develop SMB in adolescence, so that resources can be better focused to those at highest risk. Finally, we will develop and pilot an early intervention for parents aimed at reducing the risk behaviours, increasing parental understanding of mental health and ASD, and promoting resilience as a strategy to prevent the development of the most severe maladaptive behaviour. This programme involves a partnership with people with ASD, their families and the National Autistic Society (NAS). Dissemination of our findings will be led by the NAS.
SNAP (Special Needs in Autism)
SNAP (Special Needs in Autism) - Why do People with Autism Spectrum Disorders Fare so Differently in Adult Life? There is widespread concern about the adult development and outcomes for people with ASD. We are studying the Special Needs and Autism Project (SNAP) cohort, a well-characterized, longitudinal and population-representative sample of young adults with ASD to answer the following questions: (1) What is the range of outcomes for young adults? (2) What are the factors, especially from childhood and adolescence, that predict good vs. poor outcome? (3) What are the drivers of the high economic costs of ASD in adulthood, and how far can they be predicted from childhood? and (4) Can we reliably use cognitive markers for associated psychiatric problems that may help in earlier diagnosis and treatment of these additional problems? Our ultimate aim is to find novel ways to improve outcome by treating additional impairing problems. SNAP was identified from the general population, rather than from clinics, and represents the entire spectrum with respect to autism severity, IQ and family characteristics. Therefore findings from this study should represent all young adults with ASD, not just those accessing services. The cohort was previously assessed at 11/12 and 15/16 years. We are now re-assessing them at age 22/23 years because this is at the end of educational provision and a crucial time to enter employment and develop increasing independence. Findings from the SNAP cohort have been influential in the field of autism internationally, including in the estimation of prevalence, the importance of co-occurring psychiatric problems, and the nature of the cognitive phenotype. To date, there are over 30 peer-reviewed publications from SNAP published/in press/in submission. Lead Investigators: Professor Emily Simonoff, Professor Tony Charman Research Team: Jackie Briskman, Dr Rachel Kent
Validation of cognitive and physiological biomarkers of childhood anxiety in children with autism spectrum disorders
This research studies the cognitive, physiological and neuroendocrine correlates of anxiety in adolescents with autism, compared to healthy controls. Anxiety disorders are difficult to recognize in people with autism because of their communication problems. The aim of this research is to determine whether reported anxiety symptoms in young people with autism show similar cognitive and biological correlates as reported in typically developing children. It is partly funded by South London and Maudsley Charitable Foundation.
Correlates and consequences of specific language impairment: development during the first 3 years of schooling
This study determines the prevalence of specific speech and language impairments in children during their first year at school and identifies the associated neurodevelopmental and mental health problems that co-occur and develop over the early years of schooling. The study will provide a better understanding of the relation between specific impairments associated with speech and language disorders and their links to neurodevelopmental disorders. PI: Prof Courtenay Norbury, Royal Holloway It is funded by Welcome Trust.
Completed Projects
Evaluation of Diagnostic Techniques, and Cognitive and Physiological Correlates, of Anxiety in Young People with Autism Spectrum Disorders
One in ten young people under the age of 16 in the UK is thought to suffer from some form of anxiety. In children and young people with ASD, findings from epidemiological research (Simonoff et al., 2008) suggest that as many as 40% have an anxiety disorder. However, recognition and diagnosis is difficult because children with ASD may not be able to describe their feelings and emotions clearly and because anxiety symptoms can be superficially similar to core symptoms of ASD, for example social lack of interest (ASD) versus social avoidance (anxiety).
We undertook a study to examine the cognitive and biological basis of anxiety symptoms in ASD. We compared boys aged 10-16 years with ASD, either with or without an anxiety disorder, to typically developing (TD) boys on a range of cognitive and biological parameters, including during a psychosocial stress test.
This study ran between 2009-2013 and was funded by the NIHR Biomedical Research Centre for Mental Health, as one of three BRC-funded research themes within the Department of Child and Adolescent Psychiatry.
Genetic Architecture of Disruptive Disorders
Behaviour genetic studies of antisocial and aggressive behaviours have suggested that heritability for an underlying trait, as measured by both parent and child reports, may be much higher than those of individual reports. Parent and child reports contribute uniquely as each reflects different aspects of antisocial behaviour. There is some evidence that aggressive behaviour may be more highly genetically loaded than some other areas of antisocial behaviour.
Our research agrees with other studies in finding a strong genetic component to hyperactivity (attention deficit hyperactivity disorder) symptoms. It further highlights the need for considering ratings from teachers as well as parents, in taking account of behaviour that is developmentally appropriate
Aetiological Risk Factors for Moderate Learning Disabilities
Our general population study of over 2500 adolescents attending both mainstream and special schools revealed that definite medical disorders likely to account for moderate learning disability (IQ < 70) were present in just under 9% of the population. Psychiatric symptoms were increased in those with MLD, with ADHD symptoms increased 5.5-fold and emotional symptoms increased 5.8-fold. Most children (? 80%) with moderate learning disabilities were attending mainstream school.
Group lead
Professor of Child and Adolescent Psychiatry